Are There Nutrient-based Poverty Traps? Evidence on Iron Deficiency and Schooling Attainment in Peru

Chong, Alberto and Cohen, Isabelle and Field, Erica and Nakasone, Eduardo and Torero, Maximo (2014): Are There Nutrient-based Poverty Traps? Evidence on Iron Deficiency and Schooling Attainment in Peru.

Abstract

A key question in development economics is whether nutritional deficiencies generate intergenerational poverty traps by reducing the earnings potential of children born into poverty. To assess the causal influence on human capital of one of the most widespread micronutrient deficiencies, supplemental iron pills were made available at a local health center in rural Peru and adolescents were encouraged to take them up via classroom media messages. Results from school administrative records provide novel evidence that reducing iron deficiency results almost immediately in a large and significant improvement in school performance. For anemic students, an average of 10 100mg iron pills over three months improves average test scores by 0.4 standard deviations and increases the likelihood of grade progression by 11%. Supplementation also raises anemic students’ aspirations for the future. Both results indicate that cognitive deficits from iron-deficiency anemia contribute to a nutrition-based poverty trap. Our findings also demonstrate that, with low-cost outreach efforts in schools, supplementation programs offered through a public clinic can be both affordable and effective in reducing rates of adolescent IDA.

• Item Type: MPRA Paper
• Language: English
• Keywords: Poverty traps, iron deficiency, RCTs, education attainement
• Subjects: I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I2 - Education and Research Institutions > I21 - Analysis of Education; J - Labor and Demographic Economics > J1 - Demographic Economics > J16 - Economics of Gender ; Non-labor Discrimination; O - Economic Development, Innovation, Technological Change, and Growth > O1 - Economic Development > O15 - Human Resources ; Human Development ; Income Distribution ; Migration

References

Harold Alderman and Hoyt Bleakly. Child health and educational outcomes. In Paul Glewwe, editor, Education Policy in Developing Countries. University of Chicago Press, 2013. 7

Sarah Baird, Aislinn Bohren, Craig McIntosh, and Berk Ozler. Designing experiments to measure spillover and threshold effects. Working Paper, 2012.

Felipe Barrera-Osorio, Marriane Bertrand, Leigh Linden, and Francisco Perez-Calle. Improving the design of conditional cash transfer programs: Evidence from a randomized education experiment in colombia. American Economic Journal: Applied Economics, 3:167–195, 2012.

Lori Beaman, Esther Duflo, Rohini Pande, and Petia Topalova. Female leadership raises aspirations and educational attainment for girls: A policy experiment in india. Science, 335: 582–586, 2012.

GH Beaton and GP McCabe GP. Efficacy of intermittent iron supplementation in the control of iron deficiency anaemia in developing countries: an analysis of experience: final report to the micronutrient initiative. Technical report, Ottawa: Micronutrient Initiative, 1999.

Gustavo J. Bobonis, Edward Miguel, and Charu Puri Sharma. Anemia and school participation. Journal of Human Resources, 41:692–721, 2006.

Ann B Bruner, Alain Joffe, Anne K Duggan, James F Casella, and Jason Brandt. Randomised study of cognitive effects of iron supplementation in non-anaemic iron-deficient adolescent girls. The Lancet, 348:992–996, 1996.

Mary E. Cogswell, Anne C Looker, Christine M Pfeiffer, James D Cook, David A Lacher, John L Beard, Sean R Lynch, and Laurence M Grummer-Strawn. Assessment of iron deficiency in us preschool children and nonpregnant females of childbearing age: National health and nutrition examination survey 2003-2006. American Journal of Clinical Nutrition, 89(13):1334–1342,2009.

Bruno de Benoist, Eric McLean, Ines Egli, and Mary Cogswell. Worldwide prevalence of anaemia, 1993-2005. Technical report, World Health Organization, 2008.

Martin Falkingham, Asmaa Abdelhamid, Peter Curtis, Susan Fairweather-Tait, Louise Dye, and Lee Hooper. The effects of oral iron supplementation on cognition in older children and adults:a systematic review and meta-analysis. Nutrition Journal, 9(4), 2010.

Eliana Garces, Duncan Thomas, and Janet Currie. Longer term effects of head start. The American Economic Review, 92:999–1012, 2002.

Tarun Gera, H.P.S. Sachdev, Penelope Nestel, and Sudeep Singh Sachdev. Effect of iron supplementation of haemoglobin response in children: systematic review of randomised controlled trials. Journal of Pediatric Gastroenterology and Nutrition, 44:468–486, 2007.

Judith A. Groner, Neil A. Holtzman, Evan Charney, and E. David Mellitis. A randomized trial of oral iron on tests of short-term memory and attention span in young pregnant women. Journal of Adolescent Health Care, 7:44–48, 1986.

Jill S. Halterman, Jeffrey M. Kaczorowski, C. Andrew Aligne, Peggy Auinger, and Peter G. Szilagyi. Iron deficiency and cognitive achievement among school-aged children and adolescents in the united states. Pediatrics, 107, 2001.

S. E. Hutchinson, C. A. Powell, S. P. Walker, S. M. Chang, and S. M. Grantham-McGregor. Nutrition, anaemia, geohelminth infection and school achievement in rural jamaican primary school children. European Journal of Clinical Nutrition, 51:729–735, 1997.

Purmina Kashyap and Tara Gopaldas. Hematinic supplementation and hematological status of underprivileged school girls (8-15 years of age). Nutrition Research, 7(11):1127–1138, 1987.

Anthony Lambert, Karrin Knaggs, Robert Scragg, Patricia Metcalf, and David Schaaf. Effects of iron treatment on cognitive performance and working memory in non-anaemic, iron-deficient girls. New Zealand Journal of Psychology, 31:19–28, 2002.

Renfu Luo, Linxiu Zhang, Chengfang Liu, Qiran Zhao, Yaojiang Shi, Grant Miller, Elaine Yu, Brian Sharbono, Alexis Medina, Scott Rozelle, and Reynaldo Martorell. Anemia among students of rural china’s elementary schools: Prevalence and correlates in ningxia and qinghai’s poor countries. Journal of Health, Population and Nutrition, 29:471–485, 2011.

K. Macours and R. Vakis. Changing households’ investments and aspirations through social interactions: Evidence from a randomized transfer program in a low-income country. Policy Research Working Paper 5137, 2009.

Sarah Miller and Paul Connolly. A randomized controlled trial evaluation of time to read, a volunteer tutoring program for 8- to 9- year olds. Educational Evaluation and Policy Analysis, 35:23–37, 2013.

Trang Nguyen. Information, role models and perceived returns to education: Experimental evidence from madagascar. mimeo, MIT, 2008.

Ernesto Pollitt, AG Soemantri, F Yunis, and NS Scrimshaw. Cognitive effects of iron deficiency anemia. The Lancet, 325:158, 1985.

Ernesto Pollitt, Phongjan Hathirat, Nittaya J Kotchabhakdi, Lavon Missell, and Aree Valyasevi. Iron deficiency and educational achievement in thailand. American Journal of Clinical Nutrition, 50:687–697, 1989.

Javaeria Qureshi. Additional returns to investing in girls’ education: Impact on younger sibling human capital. mimeo, University of Chicago, 2011.

W. Schultink, R. Gross, M. Gliwitz, D. Karyadi, and P. Matulessi. Effect of daily vs twice weekly iron supplements in indonesian preschool children with low iron status. American Journal of Clinical Nutrition, 61:111–115, 1995.

S Seshadri and T Gopaldas. Impact of iron supplementation on cognitive functions in pre-school and school aged children: the indian experience. American Journal of Clinical Nutrition, 50:675–686, 1989.

S Seshadri, K Hirdoe, P Nalik, and S Malhotra. Behavioural responses of young anemic indian children to iron-folic acid supplements. British Journal of Nutrition, 48:233–240, 1982.

A.G. Soemantri. Preliminary findings on iron supplementation and learning achievement of rural indonesian children. American Journal of Clinical Nutrition, 50:698–702, 1989.

AG Soemantri, Ernesto Pollitt, and Inusn Kim. Iron deficiency anemia and educational achievement. American Journal of Clinical Nutrition, 42:1221–1228, 1985.

Rebecca J. Stoltzfus, Luke Mullany, and Robert E. Black. Iron deficiency anaemia. In Majid

Ezzati, Alan D. Lopez, Anthony Rodgers, and Christopher J.L. Murray, editors, Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, pages 163–210. World Health Organization, 2004.

John Strauss and Duncan Thomas. Health, nutrition and economic development. Journal of Economic Literature, 36:766–817, 1998.

Rassamee Sungthong, Ladda Mo-Suwan, Virasakdi Chongsuvivatwong, and Alan F. Geater. Once weekly and 5-days a week iron supplementation differentially affect cognitive function but not school performance in thai children. The Journal of Nutrition, 134:2349–2354, 2004.

Duncan Thomas, Elizabeth Frankenberg, Jed Friedman, Jean-Pierre Habicht, Mohammed Hakimi, Jaswadi, Nathan Jones, Christopher McKelvey, Gretel Pelto, Bondan Sikoki, Teresa Seeman, James P. Smith, Cecep Sumantri, Wayan Suriastini, and Siswanto Wilopo. Causal effect of health on labor market outcomes: Experimental evidence from indonesia. On-Line Working Paper Series 070, California Center for Population Research, 2006.

UNICEF. Situation of children in peru. Technical report, Canadian International Development Agency, 2008.

Thomas E. Webb and Frank A. Oski. Iron deficiency anemia and scholastic achievement in young adolescents. The Journal of Pediatrics, 85:827–829, 1973.

World Health Organization. Iron deficiency anemia assessment, prevention and control: A guide for programme managers, 2001.

World Health Organization. Prevetion of iron deficiency anaemia in adolescents: Role of weekly iron and folic acid supplementation. Technical report, Regional Office for South-East Asia, 2011.

Nelly Zavaleta, Graciela Respicio, and Teresa Garcia. Efficacy and acceptability of two iron supplementation schedules in adolescent school girls in lima, peru. The Journal of Nutrition, 130(2S):S462–S464, 2000.